Provider Demographics
NPI:1891741096
Name:PARKER, G. KEITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:G.
Middle Name:KEITH
Last Name:PARKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 ISLAND FORD RD
Mailing Address - Street 2:P.O. BOX 1797
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-9314
Mailing Address - Country:US
Mailing Address - Phone:828-885-2357
Mailing Address - Fax:828-883-4459
Practice Address - Street 1:BREVARD CANCER CENTER
Practice Address - Street 2:1050 NEELY ROAD
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712
Practice Address - Country:US
Practice Address - Phone:828-883-4987
Practice Address - Fax:828-883-4459
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35 NCFBPPPC101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral